The proposed project will : (a) develop a set of critera for optimal care of the EMS patient and (b) develop and prospectively test a series of clinical EMS patient care protocols or algorithms against outcome measures, such as mortality and process measures including morbidity, duration of hospitalization, ICU stay, mechanical ventilation, febrile days, complications and secondary operations required by these complications. We will use normative values where available, but we will resort to monitoring of physiologic data in those crucial issues where normative values are unclear or the issues are still controversial. We will start with the resuscitation during the first 30 minutes in common life-threatening emergency conditions; then extend this to the subsequent period of critical illness. Crieria for diagnostic activities will be defined according to clinical conditions. Since common physiologic changes occur with a wide variety of injuries, we will also define criteria for escalation of physiologic monitoring by process measures defined from the sequential physiologic patterns associated with death or survival and by outcome criteria such as mortality and morbidity rates, length of ICU stay, days on mechanical ventilation and number of febrile days. These algorithms will develop an integrated patient management plan beginning from the time immediately after the etiologic event through the initial resuscitation, early crisis period, and period of critical illness. The general problem of resuscitation as well as specific injuries and other emergency conditions will be covered. The patient's presenting condition, information from diagnostic tests and physiologic information obtained by monitoring techniques will be integrated into a comprehensive therapeutic plan; the clinical results as well as compliance with the protocol will then be tested prospectively.